The Strathmore University Prism Centre was represented at the 18th World Congress on Public Health (WCPH 2026), held in Cape Town, South Africa, from 6th to 9th September 2026. Pharmacist and Prism’s Research Assistant Dr. Makena Kithinji presented findings from the Centre’s recently concluded study mapping Kenya’s human resources for health landscape.
Her poster presentation, “Beyond County Borders: Understanding In-Country Mobility in Kenya’s Devolved Health System,” described how health workers move within and across county health systems, the processes involved, and the factors influencing their experiences of intra-county and inter-county mobility.
Dr. Makena’s presentation brought valuable Kenyan perspectives to an international conversation about health worker mobility in decentralised health systems. Health worker mobility has far-reaching implications on how health workers navigate their careers and how health systems manage and retain their workforce.
A Global Public Health Forum
Held under the theme “Health Without Borders: Equity, Inclusion, and Sustainability”, WCPH 2026 assembled researchers, practitioners, and policymakers in public health to share experiences, exchange knowledge, and explore ways to advance global public health goals. The four-day programme included poster and oral presentations, World Leadership Dialogues, plenary sessions, and keynote addresses on primary health care (PHC), health system equity, digital health innovation, sustainability, and global health governance.
During the Congress, participants engaged with interdisciplinary public health challenges, considered how these challenges play out in different settings, and shared evidence and solutions from different countries.
Understanding Healthcare Worker Mobility in Kenya
Since the devolution of government in 2013, counties are responsible for health workforce management in Kenya. While this brought healthcare management closer to counties, it also created challenges for health workers seeking to transfer.
A worker may need to transfer within the county, between counties, or from county to the national government and vice versa. Inter-county transfers can be difficult because of weak coordination between counties, differences in employment and pension terms, varying procedures, and perceptions of political and economic influence around such requests.
Dr. Makena’s research examined how mobility processes are initiated and managed, workers’ experiences of these processes, and the consequences of mobility challenges for workers, facilities, and the wider health system.
Mechanisms for Inter-County Transfers
According to the research, currently, inter-county transfers occur through the swap system or through formal application. The former is the most commonly described pathway: a health worker seeking transfer must identify a worker of similar cadre, job group, and specialisation in the destination county who wishes to transfer to their county.
These arrangements are often facilitated through WhatsApp groups and personal networks. When workers cannot find such a replacement, they are forced to remain in their current station, or wait for a vacancy in their destination county and apply through the normal recruitment process.
Dr. Makena also described a less-used formal application pathway: the worker applies to their releasing county, which forwards their application to the receiving county’s HR Office or County Public Service Board. Both counties must agree to the transfer, in which case the releasing county may advertise the resulting vacancy. However, workers described the formal pathway as lengthy and, without an influential figure supporting the transfer, often unsuccessful.
Once transferred through either method, the worker still faced the significant task of ensuring that their payslip and pension benefits were migrated to the destination county. Otherwise, the worker would neither be paid by the receiving county nor the releasing county and was at risk of losing their pension benefits altogether.
Dr. Makena highlighted several consequences of the lack of mobility for healthcare workers, including locked transfers, career stagnation, prolonged separation from family members, pension and benefit losses or discontinuities, salary and allowance inequalities across counties, and the loss of professional development opportunities, among others.
For the health system, attempts at inter-county mobility highlight the severe misdistribution of cadres across different counties. Counties have also been subjected to friction and even litigation arising from transfer disputes owing to unregulated procedures.
An In-Country Healthcare Worker Mobility Framework
The research proposes an operational inter-county Healthcare Worker Mobility framework that balances county autonomy with workers’ rights to fair labour practices. Such a framework should:
- outline mobility governance and coordination mechanisms,
- create a central digital mobility registry,
- standardise transfer protocols, including payroll transfer,
- define eligibility criteria for transfers through swaps or other means,
- define processing timelines for applications, and
- address mechanisms for harmonisation of pensions and other accrued benefits, including career gains and study leaves.
This study informs one of the key mandates of the Kenya Health Human Resource Advisory Council (KHHRAC), which is responsible for developing and overseeing the implementation of such a mobility framework. The existence of a framework would also limit the effects of external influences such as political patronage, managerial goodwill (or lack thereof), and informal networks in the transfer process.
Looking Ahead: Dissemination of the HRH Research Study Findings
Dr. Makena’s presentation at the WCPH 2026 forms part of the Prism Centre’s broader work on Human Resources for Health (HRH) in Kenya, conducted under the leadership of Centre Director, Prof. Francis Wafula, who is also the current KHHRAC Board Chairperson. It provided an opportunity to share emerging evidence from Kenya with an international audience and engage with research and experiences from other health systems.
The Centre has concluded the research phase of the HRH study, with healthcare worker mobility and deployment forming one of the components covered during the research. The team is now in the final stages of report writing and hopes to disseminate the findings to relevant stakeholders in the coming weeks. The findings will contribute to wider discussions on strengthening health workforce management and health service delivery.
Readers are encouraged to stay tuned for the forthcoming dissemination of the Human Resources for Health research findings from the Strathmore University Prism Centre.
